Provider Demographics
NPI:1306062880
Name:FORT WASHINGTON PHYSICIANS GROUP
Entity type:Organization
Organization Name:FORT WASHINGTON PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSAVATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-983-6656
Mailing Address - Street 1:PO BOX 64312
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4312
Mailing Address - Country:US
Mailing Address - Phone:301-983-6656
Mailing Address - Fax:
Practice Address - Street 1:11711 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5151
Practice Address - Country:US
Practice Address - Phone:301-203-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCN012OtherCAREFIRST OF DC GROUP NUM
DCN012OtherCAREFIRST OF DC GROUP NUM